Document Detail

The value of urgent carotid surgery for crescendo transient ischemic attacks.
MedLine Citation:
PMID:  17543679     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study audited operative risk in patients undergoing urgent carotid surgery for crescendo transient ischemic attacks (TIAs).
METHODS: Interrogation of the vascular unit database (January 1992 to July 2004) identified 42 patients operated on urgently for crescendo TIAs, which were defined as>or=3 TIAs within the preceding 7 days. Stroke, death, and any major cardiac events were analyzed.
RESULTS: Thirty-nine patients underwent conventional endarterectomy, and three underwent interposition vein bypass. Crescendo TIA patients had sustained a median of five TIAs (range, 3 to 20) in the 7 days before surgery. Three patients died or had a stroke after surgery, for a combined stroke/death rate of 7%. This compares with 2.4% in 1000 patients undergoing elective carotid endarterectomy in this unit during the same time period. The combined stroke/death/major cardiac event rate was 14% (n=6).
CONCLUSIONS: The combined risk of neurologic and cardiac complications after urgent carotid surgery for crescendo TIA is higher than that expected after elective cases but is still acceptable considering the natural history of patients with unstable neurologic symptoms.
Christos D Karkos; Greg McMahon; Mark J McCarthy; Martin J Dennis; Robert D Sayers; Nicholas J M London; A Ross Naylor
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  45     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-06-04     Completed Date:  2007-07-13     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1148-54     Citation Subset:  IM    
Department of Vascular and Endovascular Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
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MeSH Terms
Aged, 80 and over
Anastomosis, Surgical / adverse effects
Carotid Artery, Internal / surgery*
Databases as Topic
Emergency Medical Services* / statistics & numerical data
Endarterectomy, Carotid / adverse effects*,  statistics & numerical data
Great Britain / epidemiology
Heart Diseases / epidemiology,  etiology*
Ischemic Attack, Transient / complications,  mortality,  surgery*
Medical Audit* / statistics & numerical data
Middle Aged
Risk Assessment
Risk Factors
Saphenous Vein / transplantation*
Stroke / epidemiology,  etiology*
Time Factors
Treatment Outcome
Comment In:
J Surg Educ. 2010 Jul-Aug;67(4):196-9   [PMID:  20816352 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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